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Brijnath B, Rao R, Baruah U, Antoniades J, Loganathan S, Varghese M, Cooper C, Kent M, Dow B. Relational Solidarity and Conflicting Ethics in Dementia Care in Urban India. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae079. [PMID: 38708694 PMCID: PMC11157626 DOI: 10.1093/geronb/gbae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES Using the concept of relational solidarity, we examine how autonomy, equality, dignity, and personhood are practiced in the care of people living with dementia at home in urban India. METHODS Video interviews with 19 family carers and 25 health providers conducted in English, Hindi, and Kannada in Bengaluru between March and July 2022. Data were translated into English and thematically analyzed. RESULTS Family carers and providers unanimously agreed that people with dementia should be respected and cared for. Concurrently, they perceived people with dementia as being "like a kid" and used the analogy of a parent-child relationship to understand their care responsibilities. This analogy informed how ethical principles such as personhood and equality were reframed in the relationships between family carers and people with dementia, as well as how carers and providers maintained the safety but undermined the autonomy of people with dementia through restricting their movements inside and outside the home. DISCUSSION There can be relational solidarity in dementia care at home in urban India but also contradictions in the interpretations and applications of the ethical principles of autonomy, equality, dignity, and personhood. As such, a more organic, grassroots model of ethical practice is needed to frame care and provide material support to families in India.
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Affiliation(s)
- Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachita Rao
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Upasana Baruah
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Josefine Antoniades
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Santosh Loganathan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, St John’s Medical College, Bengaluru, Karnataka, India
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Mike Kent
- School of Media, Creative Arts and Social Inquiry, Curtin University, Perth, Western Australia, Australia
| | - Briony Dow
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Director Division, National Ageing Research Institute, Melbourne, Victoria, Australia
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Clark I. The experiences of people living with dementia and their care partners participating in an online therapeutic songwriting program. DEMENTIA 2024; 23:251-271. [PMID: 38131325 PMCID: PMC10807188 DOI: 10.1177/14713012231224069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND AIM Despite the impact of dementia on close care relationships, accessible therapeutic services for people living with dementia and their care partners remain scarce. Further, there is an increasing demand for online services, highlighting the need for ongoing telehealth research. This study aimed to explore the experiences of people living with dementia and their informal and formal care partners following participation in a 10-week online therapeutic songwriting program. METHODS The songwriting program included four duo and six group sessions facilitated by a music therapist. Post-program semi-structured interviews were analysed using thematic analysis. FINDINGS Nine people with dementia and six care partners (nine duos) participated in the program. Five duos were in spousal relationships and four people with dementia participated with a formal care partner. Participants attended an average of four duo sessions and three group sessions. Six people with dementia and five care partners participated in post-program interviews. Four themes were developed: (1) No one else does this; (2) It's all about us as people; (3) After the sessions we'd come out buzzing; and (4) The journey was as important as the product. CONCLUSIONS Participants highlighted songwriting as a unique opportunity to connect with music, experience welcomed challenges, and spend 'real time' together. The program drew on participants' lived experience and promoted connection with others, resulting in feelings of enjoyment, enhanced mood, and achievement. Participants valued both the songwriting process and song product, emphasising the importance of sensitive and skilful facilitation. Our findings suggest that these distinct benefits were not available through other support services. Further, online songwriting is a viable option for people living with dementia and their care partners where in-person sessions are not available or accessible.
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Affiliation(s)
- Imogen Clark
- Faulty of Fine Arts and Music, University of Melbourne, Australia
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Huggins M, Puurveen G, Pesut B, Rush K. Competency development for a volunteer navigation program to support caregivers of people living with dementia: A modified e-Delphi method. DEMENTIA 2024; 23:69-90. [PMID: 37976553 PMCID: PMC10797849 DOI: 10.1177/14713012231216768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Caregivers of people living with dementia are pillars of the care community. Providing them with adequate support throughout their caregiving journey is essential to their quality of life and may also contribute to improving the care of people living with dementia. Nav-CARE (Navigation - Connecting, Advocating, Resourcing, Engaging) is a volunteer-led navigation program that provides support to older adults with life-limiting illnesses who are living in the community. However, Nav-CARE does not provide support directly to caregivers of people living with dementia. To adapt Nav-CARE to support caregivers, we needed to establish caregivers' needs and the competencies volunteer navigators should be trained in to support caregivers to meet these needs. To do so, a modified e-Delphi method was utilized, which consisted of administering three sequential questionnaires to a panel of 35 individuals with expertise in a variety of dementia related domains. Through this, two final lists of 46 caregivers' needs and 41 volunteer competencies were established to inform the development of volunteer navigator training curriculum. Findings suggest that trained volunteer navigators may be able to support caregivers of people living with dementia throughout the disease trajectory and can be used to inform the development of future dementia navigation programs.
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Affiliation(s)
- Madison Huggins
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
| | - Gloria Puurveen
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
| | - Barb Pesut
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
| | - Kathy Rush
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
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Chan OF, Chui CHK, Wong GHY, Lum TYS. Threats to personhood from within the family? A study of family caregivers of people with dementia in the Chinese context. DEMENTIA 2023; 22:1677-1694. [PMID: 37534460 DOI: 10.1177/14713012231193144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Dementia care creates ethical and legal dilemmas due to the struggle to balance the quality of care and personhood. Disagreement and conflict in caregiving relationships are common. However, limited attention has been given to particular stressful circumstances, such as care practice and decision disagreements. Moreover, the cultural context of personhood has been overlooked. This study drew on Hong Kong family caregivers' reports of their cargiving practice and disagreements with care recipients about care-related decisions and their implications for personhood to identify person-centered family care support needs. RESEARCH DESIGN AND METHODS We conducted 18 semi-structured interviews with family caregivers of people with dementia in Hong Kong, China. Participants were asked to share their family dementia caregiving experience and practice, specifically regarding decisions and practices that elicited disagreement. We used thematic analysis to analyze data generated from interviews. RESULTS Six caregiver practices were identified: exchange for mutual agreement, a foot-in-the-door approach, acceptance of requests/behaviors contrary to the caregivers' views, infantilization, treachery, and exclusion and imposition. DISCUSSION AND IMPLICATIONS These findings highlight the importance of providing support and guidelines for person-centered care to promote personhood in the family caregiving context in dementia care.
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Affiliation(s)
- On-Fung Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Cheryl Hiu-Kwan Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Gloria Hoi-Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Terry Yat-Sang Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
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Chen AT, Teng AK, Zhao J, Asirot MG, Turner AM. The use of visual methods to support communication with older adults with cognitive impairment: A scoping review. Geriatr Nurs 2022; 46:52-60. [PMID: 35605551 PMCID: PMC10033830 DOI: 10.1016/j.gerinurse.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
Abstract
Older adults with cognitive impairment often face difficulties with comprehension and communication, which can impact other cognitive processes such as decision-making. This scoping review investigates how visual methods can support older adults with cognitive impairment. The review involved querying four databases. From these databases, eleven articles fit inclusion criteria. This paper examines the purposes, use contexts, types, and effectiveness of the visual methods described in each study. The two major use contexts were elicitation of thoughts, feelings, and preferences in everyday life and health/healthcare related uses. Studies that used visual methods for eliciting preferences generally employed static visualizations. Health-related contexts employed more complex and interactive visualizations. Three studies used visual tools to support older adults in understanding; six, communication; and three, decision-making. None addressed all three outcomes of interest. This study provides recommendations and future directions for visual communication research with older adults with cognitive impairment.
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Affiliation(s)
- Annie T Chen
- Department of Biomedical Informatics and Medical Education, UW Medicine South Lake Union, University of Washington School of Medicine, 850 Republican Street, Box 358047, Seattle, WA 98109, United States.
| | - Andrew K Teng
- Department of Biomedical Informatics and Medical Education, UW Medicine South Lake Union, University of Washington School of Medicine, 850 Republican Street, Box 358047, Seattle, WA 98109, United States
| | - Jillian Zhao
- Human-Centered Design and Engineering, College of Engineering, University of Washington, United States
| | - Mary Grace Asirot
- Department of Health Systems and Population Health, School of Public Health, University of Washington, United States
| | - Anne M Turner
- Department of Biomedical Informatics and Medical Education, UW Medicine South Lake Union, University of Washington School of Medicine, 850 Republican Street, Box 358047, Seattle, WA 98109, United States; Department of Health Systems and Population Health, School of Public Health, University of Washington, United States
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O’Donnell E, Holland C, Swarbrick C. Strategies used by care home staff to manage behaviour that challenges in dementia: a systematic review of qualitative studies. Int J Nurs Stud 2022; 133:104260. [DOI: 10.1016/j.ijnurstu.2022.104260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 02/14/2022] [Accepted: 04/17/2022] [Indexed: 11/24/2022]
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Davies M, Zúñiga F, Verbeek H, Simon M, Staudacher S. Exploring Interrelations Between Person-Centred Care and Quality of Life Following a Transition into Long-Term Residential Care: A Meta-Ethnography. THE GERONTOLOGIST 2022; 63:660-673. [PMID: 35176167 PMCID: PMC10167765 DOI: 10.1093/geront/gnac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Globally, a culture change in long-term residential care (LTRC) moving towards person-centred care (PCC) has occurred in an attempt to improve resident quality of life (QoL). However, a clear understanding of how different aspects contributing to a PCC approach are interrelated with resident QoL is still lacking. This review explores interrelating aspects between PCC and QoL in LTRC using qualitative synthesis. RESEARCH DESIGN AND METHODS Ten relevant primary studies were identified from a search of interdisciplinary research databases providing qualitative information. Studies were critically reviewed for key themes and concepts by the research team. We used a meta-ethnography approach to inductively interpret findings across multiple studies and reinterpreted the information using a constructivist approach. RESULTS We identified 5 second order constructs sharing commonalities suggesting interrelations between PCC and QoL: (1) Maintaining dignity, autonomy and independence. (2) Knowing the whole person. (3) Creating a 'homelike' environment. (4) Establishing a caring culture. (5) Integrating families and nurturing internal and external relationships. Synthesis translation led to the following third order constructs: (1) Personalising care within routines (2) Optimising resident environments (3) Giving residents a voice. DISCUSSION AND IMPLICATIONS There are many interrelating aspects of PCC and QoL following a permanent transition into LTRC, but successful implementation of PCC, which enhances QoL presents challenges due to organisational routines and constraints. However, by prioritising resident voices to include their needs and preferences in care, QoL can be supported following a transition into LTRC.
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Affiliation(s)
- Megan Davies
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Franziska Zúñiga
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Michael Simon
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Sandra Staudacher
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Lynn JD, Ryan A, McCormack B, Martin S. A Qualitative Exploration of Living with Dementia in Supported Living Environments using a Peer Researcher Approach. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Goodall G, Taraldsen K, Granbo R, Serrano JA. Towards personalized dementia care through meaningful activities supported by technology: A multisite qualitative study with care professionals. BMC Geriatr 2021; 21:468. [PMID: 34418973 PMCID: PMC8380345 DOI: 10.1186/s12877-021-02408-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Person-centred care is widely recognised as important for helping people with dementia maintain a sense of self and purpose in life - especially for those living in care facilities. Despite this, most care practices still adopt a medical approach in which physical needs are prioritized over psychosocial well-being. Addressing the need to find ways of promoting person-centred approaches in care, this study explored care professionals' reflections on a novel, technological intervention (SENSE-GARDEN) that combines multisensory stimuli and digital media to create personalized environments for people with dementia. The aim of this study was to explore the experiences of care professionals who had used SENSE-GARDEN for approximately 1 year. METHODS Three care homes in Norway, Belgium, and Portugal and 1 hospital in Romania used the SENSE-GARDEN with residents/patients with moderate to severe dementia over the course of 1 year. Qualitative data - including observations and interviews with 2 care professionals - were collected at the beginning of the study period from the Norwegian care home to explore initial impressions of the new SENSE-GARDEN room. At the end of the study period, 8 care professionals across the 4 facilities were interviewed for an in-depth exploration of their experiences. The two sets of data were analysed separately through reflexive thematic analysis. RESULTS At the beginning of the study period, the staffs' focus was mainly on the novelty of the new SENSE-GARDEN room and how it provided opportunities for meaningful experiences. Post-intervention, the care professionals provided reflective accounts on how care could be delivered in alternative ways to standard practice. The themes generated from the post-intervention interviews were: "shifting focus onto personalized care", "building and fostering relationships", and "continuous discoveries". Through delivering person-centred care, the professionals reported a sense of purpose and achievement in their work. CONCLUSIONS Professionals from care facilities across 4 different countries highlighted the value of interventions such as SENSE-GARDEN as a way of creating opportunities to better know people with dementia. Thus, they experienced improved relationships and greater job satisfaction. However, delivering person-centred interventions is time-consuming, and future research should evaluate the feasibility of sustaining them on a long-term basis.
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Affiliation(s)
- Gemma Goodall
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Randi Granbo
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - J Artur Serrano
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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